,

·FORM2H
(See rule 4)
NOMINATION PAPER
Election to the Legislative Assembly of Sikkim from Sangha Constituency

Recent stamp size

(2cm X 2.5cm)
photograph in
white/off white
background with
full face view to
be nttnrh.ed.

PART 1*
(To be used by candidate set up by recognised political party)

Inominate as a candidate for election to the Legislative Assembly of Sikkim from the Sangha
Constituency.

Candidate's name '" ( ~ather's/mother's/husband's name

.... . ... . . .. . . .. . . . . . . . . . . . . . . . . .. ..... . His postal address ~ .' ; ..
..................................................... ; His naifie1~ entered at S. No ~ .
. .' . .
in part number ~ of the electoral roll for the Sangha Assembly Constituency.
My name is .~.. :.. ~ and it is entered at S.No ~ in Part
No of the electoral roll for the Sangha Constituency. ..

'Date : ; .. Signature of proposer

PART 11*
(To be used by the candidate not set up by the recognized political party)

. We hereby nominate as candidate for election to the Legislative Assembly of Sikkim from the
Sangha Constituency,
Candidate's name Father's/mother's/husband's name
His postal address
............., _. _: ~ ,. His name. is enteredat S. NQ.. ~.._.'"._. e.••. , !.'. _.. ill
part number ofthe electoral roll for the Sangha Constituency.
*Strike out the part which is not applicable.

. .
 ,
We declare that we are electors of this Assembly Constituencyand our names are entered in
the electoral roll for this Assembly Constituency as indicated below and we append our
signatures below in tokenof subscribing to this nomination:-
. Iars 0 ftb e proposers an d th err
P articu . sIgnatures
Sl. No. Elector Roll No. of Full Name Signature Date
Pr()poser
Part No. of S.No. in
Electoral that part
Roll of the
Constituency
1 2 3 4 5 6
l.
2.
3.
4.
5.
6.
7.
8.
9.
10. (,
..J
N.B. There should be ten electors of constituency as proposers as requir~,nder the provisoto
sub-section (1) of section 33 of the Representation of the People Act, 1951. ..

PART III

I, the candidate mentioned in Part 1*IPart II* assent to this nomination and hereby declare
that:- .
(a) I am a citizenofIndia and have not acquired the citizenshipof any foreign State.
(b) I have completed years of age;
(c) (i) * I am set up at this election by the .......:..........party, which is recognised National
Party/*State Party* in this State and that the symbol reserved for the above party be allotted to
me.
(ii)* I am set.upat this election by the arty, which is a registered-
unrecognized political party*Ithat 1am contesting this election as an independent candidate * and
that the symbols I have chosen,in order of preference, are:-
(1) (2) (3) _
(d) My name and my father's/mother's/husband's name have been correctly spelt out
above in (nameof the language).
(e) To the bestof my knowledge and belief, I am qualified and not also disqualified for
being chosen to fill the seatin the Legislative Assembly of this State.

I further-declare thatI am a member of the Sangha Community.

c. '
"'-.
I also declare that I have not been, and shan not be nominated as a candidate at the
present general election/the bye-elections being held simultaneously, to the Legislative
Assemblyof Sikkim from more than two Assemblyconstituencies.

Date .
Signature of Candidate

N.B.-A 'recognised political party' means a political party recognised by the Election Commission under the
ElectionSymbols(Reservation and Allotment) Order, 1968inthe State of Sikkim.
* Strikeoutwhich is not applicable.

PART IV
(To be filled by the candidate)
(1) Whether the candidate-
(i) has been convicted-

(a) of any offence(s) under sub-section (1); or

(b) for contravention of any law specified in sub-section (2), (.

of section 8 of the Representation of the People Act, 1951 (43 of 1951); or YeslNo .
' .
.J

(ii) has been convicted for any other offence(s) for which he has been
..--,
sentenced to imprisonment for two years ormore,

If the answer is "Yes", the candidate shall furnish the following information:
(i) Case/First information report No.lNos .. : .
. '.

(ii) Police Station(s) .. , District(s) , State(s) : ~.

.(iii} .. Section/s) of the concerned Act( s) and brief description of the offence( s) for which he
has been convicted .
(iv) Date(s) of conviction/s) .
(v) Court(s) which convicted the candidate .
(vi) Punishment(s) imposed [indicate period ofimprisonment(s) and/or quantum of
fine(s)] .

(vii) Date(s) of release from prison .

(viii) Was/were any appeal(s)/revision(s) filed against above
. conviction(s) Yes/No.
(ix) Date and particulars of appeal(s)/application(s) for revision
filed : .
 (
' ....
(x) Name of the court(s) before which the appeal(s)/application(s) for revision
filed .
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or
is/are pending ..
(xii) If the said appeal(s)/application(s) for revision haslhave been disposed of-
(a) Date(s) of disposal. ..
(b) Nature of order(s) passed .

(2) Whether the candidate is holding any office of profit under the Government of India or
the State Government? (YesINo)
-If Yes, details of the office held ..
(3) Whether the candidate has been declared as an insolvent by anyCourt? (YesINo)
-If Yes, has he been discharged from insolvency ..
(4) Whether the candidate is under allegiance or adherence to any foreign
country? ~....... ~(Yes/N 0)
-If Yes, give details ..
(5) Whether the candidate has been disqualified under section 8A of the Representation of
the People Act, 1951, by an order of the President? (YesINo)
-If Yes, the period for which the candidate has been (
disqualified - , .
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding
office under the Government oflndia or the Government of any State? ......... (YesINo)
-If Yes, the date of such dismissal.. .
(7) Whether the candidate has any subsisting contract(s) with the Government either in
individual capacity or by trust or partnership in which the candidate has a share for
supply of any goods to that Government or for execution of works undertaken by that
Government? (Yes/No)
-If Yes, with which Government . and details of subsisting
contract(s)........................................................................................................... .
(8) Whether the candidate is a managing agent, or manager or secretary of any company or
Corporation (other than a co-operative society) in the capital of which the Central
Government or the State Government has not less than twenty-five percent share? .
(Yes/no)
-If Yes, with which Government and the details thereof : ..
(9) Whether the candidate has been disqualified by the Election Commission under section
lOA of the Representation of People Act, 1951. (YesINo)
-If yes, the date of disqualification .

Place:
Signature of the Candidate
Date:
 (

'.

PARTV
(To be filled by the Returning Officer)
Serial numberof nomination paper ..;__
__
This nominationwas delivered to me at my Office at (hour) on (date) by
the *candidatel *proposer _

Date .. Returning Officer

*Strike out which is not applicable.

PART VI
Decisionof Returning Officer accepting or rejectingthe nomination paper
I have scrutinizedthis nomination paper in accordance with the provisions of section 36
of the Representationof the People Act, 1951 and decide as fol1ows:-

Date . Returning Officer

PART VII
Receipt for Nomination Paper and Noticeof Scrutiny
(To be handed over to the person presenting the nomination paper)

Serial No. of nominationpaper .

The nomination paper of.. a candidate for election from the Sangha Constituency was
delivered to me at my office at.. (hour) on........,...(date) by the "candidate/tproposgr.
All nomination papers will be taken up for scrutiny at (hour)
on (date) at (place).

Date . . Returning Officer - -

*Score out which is not applicable. -